Also by the Author

Thursday, May 26. 2011

Doctors used to come to your home when you or a family member became ill. That practice all but disappeared over the course of the last century. While there are still some doctors who differentiate themselves by traveling to the patient, advanced technology is giving new meaning to the term “house calls.”

Telemedicine was originally conceived as a way for patients in rural and remote areas to consult with specialists in urban areas. However, the applications for telemedicine have evolved since then. Two are of particular interest to individuals: (1) in-home monitoring of elderly and chronically ill patients and (2) telephone- and Web-based consultation.

In-home monitoring helps the patient live independently and gives their family the comfort of knowing that medical assistance is never far away. For example, Verizon and Healthsense recently announced plans to provide “wellness and health monitoring services” to seniors in assisted-living communities. The services are delivered over Verizon’s fiber optic network to Healthsense’s in-building Wi-Fi wireless networks. Healthsense provides around-the-clock vital signs monitoring, emergency signaling, and medication prompting.

Another group of companies offers access to physicians via telephone, email, and Web-based videoconference. They mainly target individuals and families with frequent non-emergency needs—for example, mothers with small children. AmeriDoc offers information, diagnosis, and prescriptions (with restrictions) to monthly subscribers. In addition to individuals and families, the company targets students and travelers. Teladoc provides similar services to plan members who are asked to set up electronic health records when they enroll. American Well “extends traditional healthcare services to the home setting” via Web conferencing, telephone, and secure chat. Notes from consultations are used to create an electronic health record (“My History”) and are forwarded to the member’s primary care physician.

You can probably see where this is leading. It’s no fun dragging yourself to a doctor’s office when you are sick. Nor is it wise for you to sit in a waiting room filled with people sneezing and coughing when all you have is a sore back. Eventually, most physicians will offer Web-based videoconferencing as an alternative to office visits for certain patients and conditions.

And I predict it will take off once someone produces an affordable and easy-to-use digital stethoscope with USB connectivity.

UPDATE: June 4, 2011

You knew there had to be a smartphone angle. Startup Cellscope is working to transform the mobile phone camera into a diagnostic-grade microscope. The company says the technology is well suited to applications such as home-based diagnosis of pediatric ear infections.

I am also certain it will take off, if only because it will be much more profitable for physicians to treat a patient without taking up an examination room. But I am not so sure it is wise. Without having the opportunity to touch and properly listen to the body, much of the information that a physician uses to make a proper diagnosis will be missing. For example, how is palpation going to work with telmedicine?

That's a good point. I should have emphasized that telemedicine is offered as a complement to office visits. But there is the danger that it could become a replacement. As the technology advances, that danger will grow.

There are solutions to the problem. Telemedicine services could require that you have at least one in-person exam per year. And there should be an understanding that sometimes the "prescription" from a tele-consultation is to go to the ER or doctor's office.

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